Women fare worse after stroke
When it comes to men and women, stroke knows no boundaries.
When it comes to men and women, stroke knows no boundaries. Yet, gender does play a significant role when it comes to assessing outcomes and interventions. Exploring these sex-specific factors is the focus of Friday’s session, “Beyond Observations: Interventions to Reduce Sex Differences in Stroke.”
Hoang Phan, PhD, a stroke epidemiologist at The University of Tasmania and Monash University in Australia, is among the session’s presenters. She explores the current evidence on the differences between women and men in stroke severity and long-term outcomes after stroke. A host of epidemiological and clinical studies have identified that women have worse outcomes after stroke than men, Dr. Phan said.
“Biologic sex can make a difference for some factors that are important to brain health in general, and to stroke in particular, such as general health status, cerebrovascular anatomy and function, health risks and behaviors,” she said. “This includes unique risk factors such as pregnancy and preeclampsia, and therapeutic response.”
Specifically, according to Dr. Phan, evidence from the International Stroke Outcomes Study (INSTRUCT) has shown that women are about 35% more likely to die and 32% more likely to have a poor functional outcome up to 5 years after a stroke compared to men. Causes of death also differ between sexes with women having more deaths attributed to stroke or other cardiovascular diseases, Dr. Phan said.
“What underlies these differences is not fully understood. The sex differences in outcomes after stroke are mostly explained by women’s older age at the time of the stroke, greater pre-stroke functional limitations and more severe strokes than men. The presence of atrial fibrillation and lower aspirin administration also account for the greater mortality in women. Women had worse quality of life than men after stroke, with the difference mostly explained by age and stroke severity, but also post-stroke depression,” Dr. Phan said. “After accounting for age, stroke severity and activity limitations, work status, social factors and cognition, women are still significantly more likely to have a higher incidence of depressive symptoms than men. There might be other biological, social or psychological differences between men and women accounting for residual differences in outcomes.”
These findings highlight the importance of better management of vascular risk factors and comorbidity in the elderly, particularly with women, she said. Such evidence also suggests opportunities for interventions to reduce sex differences in stroke outcome. According to Dr. Phan, interventions include better access to evidence-based care for cardiovascular and general health as well as opportunities for post-stroke rehabilitation, especially targeting those with less capacity to recover (i.e. pre-stroke functional limitation, more severe strokes and mood disorders).
“Fortunately, current findings show tremendous promise for the future of personalized medicine in stroke prevention and treatment,” she said. “It is essential for health care providers to recognize possible sex differences in stroke presentation — for example, greater non-traditional stroke symptoms in women — and factors that affect treatment and outcomes between sexes, such as age and pre-stroke function, and the importance of frailty in women. It is possible that the use of preventative medications, including antiplatelets, glucose-lowering agents and lipid lowering agents, may influence the sex differences.”
